Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan.
Department of Post-Baccalaureate Medicine and Brain and Neuroscience Research Center, College of Medicine, National Chung Hsing University, Taichung, Taiwan.
Front Endocrinol (Lausanne). 2024 Apr 17;15:1377923. doi: 10.3389/fendo.2024.1377923. eCollection 2024.
We explore the effect of suboptimal glycemic control on the incidence of diabetic peripheral neuropathy (DPN) in both non-elderly and elderly patients with type 2 diabetes mellitus (T2DM).
A 6-year follow-up study (2013-2019) enrolled T2DM patients aged >20 without DPN. Participants were classified into two groups: those below 65 years (non-elderly) and those 65 years or older (elderly). Biochemical measurements, including glycated hemoglobin (HbA1C), were recorded regularly. DPN was diagnosed using the Michigan Neuropathy Screening Instrument examination. The outcome was DPN occurrence in 2019.
In 552 enrollments (69% non-elderly), DPN occurred in 8.4% non-elderly and 24.0% elderly patients. A higher initial HbA1C level was significantly linked with a higher risk of future DPN in the non-elderly group (adjusted odds ratio [AOR] 1.46, 95% CI 1.13-1.89, p=0.004). In comparison, HbA1c at the end of the study period was not associated with DPN in the non-elderly group (AOR 1.17, 95% CI 0.72-1.90, p=0.526). In the elderly group, no statistical relationship was found between HbA1C levels and DPN, either in 2013 or in 2019.
Suboptimal glycemic control at baseline, rather than at the end of the study period, predicts an increased risk of future DPN in individuals with T2DM under age 65. This correlation is not seen in elderly patients. Therefore, we recommend implementing enhanced glycemic control early in middle-aged T2DM patients and propose individualized therapeutic strategies for diabetes in different age groups.
本研究旨在探讨血糖控制不佳对 2 型糖尿病（T2DM）非老年和老年患者发生糖尿病周围神经病变（DPN）的影响。
这是一项为期 6 年的随访研究（2013-2019 年），纳入了年龄>20 岁且无 DPN 的 T2DM 患者。将参与者分为两组：年龄<65 岁（非老年）和年龄≥65 岁（老年）。定期记录生化指标，包括糖化血红蛋白（HbA1C）。采用密歇根神经病变筛查量表诊断 DPN。研究终点为 2019 年 DPN 的发生情况。
在 552 名入组患者（69%为非老年）中，非老年组和老年组分别有 8.4%和 24.0%的患者发生 DPN。初始 HbA1C 水平较高与非老年组未来发生 DPN 的风险增加显著相关（校正优势比[OR] 1.46，95%可信区间 1.13-1.89，p=0.004）。相比之下，HbA1c 在研究期末与非老年组 DPN 之间无关联（OR 1.17，95%可信区间 0.72-1.90，p=0.526）。在老年组中，HbA1C 水平与 2013 年或 2019 年的 DPN 之间均无统计学关联。
与研究期末 HbA1C 水平相比，T2DM 非老年患者基线时血糖控制不佳预示着未来发生 DPN 的风险增加。这种相关性在老年患者中不存在。因此，我们建议在中年 T2DM 患者中早期实施强化血糖控制，并针对不同年龄组的糖尿病提出个体化的治疗策略。
